Behavior Problems in Infancy: A Preventive Intervention

描述(由申请者提供)：这项以患者为导向的指导研究职业发展奖(K23)的目标是让巴格纳博士为独立的临床研究职业生涯做好准备，专注于为婴儿及其家人开发预防性干预措施。巴格纳博士的长期职业目标是开发一个跨学科研究项目，检验针对有外在行为问题风险的婴儿的有效干预措施，并帮助推进对有其他行为和情绪问题的婴儿的循证实践。在K23培训计划的背景下，Bagner博士的短期培训目标是：(1)获得关于婴儿发展的独特过程的专门培训，包括典型和高危人群，以及基于关系的干预措施的性质；(2)获得在婴儿及其家庭中进行家庭预防试验的设计、执行和分析方面的知识和专门知识；以及(3)扩大对与开展低收入家庭干预研究有关的伦理和多元文化问题的理解。这项培训计划将得到：(A)温迪·西尔弗曼博士、巴里·莱斯特博士、大卫·奥兹博士、洛林·巴里克博士、爱丽丝·卡特博士、詹姆斯·贾卡德博士、威廉·佩勒姆博士和何塞·罗莎-奥利瓦雷斯博士的专家指导；(B)正式课程和研讨会；(C)指导阅读；(D)婴儿心理健康领域的重点临床经验；(E)佛罗里达国际大学和迈阿密儿童医院提供的各种资源；以及(F)拟议研究项目的实施。巴格纳博士将实施一项为期5年的研究，在这项研究中，他将开发和评估对有外在行为问题风险的婴儿进行预防性干预的潜在效果。该干预措施将是亲子互动疗法的改编，适用于家庭环境中的婴儿(即PCIT-I)。拟议奖励的前18个月将专门用于开发PCIT-I并在公开试验中进行试点。随后，巴格纳博士将进行一项小型随机试验，将PCIT-I与标准护理进行比较。有关PCIT-I的可行性和可接受性以及研究结果的临床意义的数据，将与统计分析的结果相结合，用于R01第二阶段临床试验的申请。 公共卫生相关性：儿童早期外化行为问题的负面后果在低收入家庭中表现得过于明显，是一个重大的公共卫生问题。尽管最近的研究发现，外化行为问题最早可以在12个月时被发现，但对低收入家庭婴儿后来的外化行为问题的预防研究有限。

DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to prepare Dr. Bagner for an independent clinical research career focused on developing preventive interventions for infants and their families. Dr. Bagner's long-term career goals are to develop a transdiciplinary research program examining effective interventions for infants at risk for externalizing behavior problems and help advance evidence-based practice for infants with other behavioral and emotional problems. In the context of the K23 training plan, Dr. Bagner's short-term training goals are to: (1) acquire specialized training in the unique processes of infant development, including typical and at-risk populations, and the nature of relationship-based interventions; (2) gain knowledge and expertise in the design, execution, and analysis of conducting home- based prevention trials with infants and their families; and (3) broaden understanding of ethical and multicultural issues relevant to conducting intervention research with low-income families. This training plan will be facilitated by: (a) expert mentorship from Drs. Wendy Silverman, Barry Lester, David Olds, Lorraine Bahrick, Alice Carter, James Jaccard, William Pelham, and Jose Rosa-Olivares; (b) formal coursework and seminars; (c) directed readings; (d) focused clinical experiences in the area of infant mental health; (e) the diverse resources available at Florida International University and Miami Children's Hospital; and (f) implementation of the proposed research project. Dr. Bagner will implement a 5-year research study in which he will develop and evaluate the potential efficacy of a preventive intervention for infants at risk for externalizing behavior problems. The intervention will be an adaptation of Parent-Child Interaction Therapy for use with infants in the home setting (i.e., PCIT-I). The first 18 months of the proposed award will be devoted to developing PCIT-I and piloting it in an open trial. Subsequently, Dr. Bagner will conduct a small randomized trial comparing PCIT-I to standard care. Data concerning the feasibility and acceptability of PCIT-I and clinical significance of findings, combined with results from statistical analyses, will be used to inform an R01 application for a stage II clinical trial. PUBLIC HEALTH RELEVANCE: Negative outcomes of early externalizing behavior problems in childhood are overrepresented in low-income families and represent a significant public health concern. Despite recent findings that externalizing behavior problems can be identified as early as 12 months, there has been limited research examining the prevention of later externalizing behavior problems in infants from low-income families.